NURG 533 Final Study Guide

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Feb 20, 2024

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NURG 533: Advanced Physiology and Pathophysiology Mid-Term Study Guide CELLULAR BIOLOGY -- Plasma membranes are composed of what two main components? Lipids and proteins -- Transportation across selectively permeable plasma membranes via active transport involves transporting molecules from regions of low concentration to regions of high concentration with the aid of transport molecules in the cell membrane an energy in the form of ATP. -- Which of the following is important to the survival of a cell due to its ability to control the composition of the space that it encloses? Plasma membrane -- Types of specialized tissue: Epithelial – covers most of the internal and external surfaces of the body Connective – most common as the framework on which epithelial cells cluster to form organs Muscle – composed of long, thin cells or fibers call myocyte, which are highly contractile. Neural – composed of highly specialized cells called neurons, which receive and transmit electrical impulses -- The resting membrane potential is about -70 millivolts. Changes in resting membrane potential convey messages from cell to cell. When there is a net movement of sodium into the cell, the negativity value in millivolts become “zero” this is called? Depolarization -- Most of a cell’s genetic information, including RNA and DNA, is contained in the: nucleolus -- What are the two main types of cell death? Necrosis and apoptosis -- In cellular metabolism, the process by which energy is released is: Catabolism -- Which component of the cell produces hydrogen peroxide (H2O2) by using oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction? Peroxisomes -- Which form of cell communication is used within the cell itself and will allow ions to travel from the inside of one cell to the inside of another cell? Also, if not present, it can result in the formation of cancerous tumors. Protein channel (gap junction) -- What organic compound facilitates transportation across cell membranes by acting as receptors, transport channels for electrolytes, and enzymes to drive active pumps? Proteins -- A patient who has diarrhea receives a 3% hypertonic saline solution intravenously to replace the sodium and chloride lost in the stool. What effect will this fluid replacement have on cells? They will shrink

-- Passive transport is best described with which statement? Being driven by osmosis, hydrostatic pressure, and diffusion. -- What causes the rapid change in resting membrane potential to initiate an action potential? Sodium gates open and sodium rushes into the cell, changing the membrane potential from negative to positive. -- Which statement is true about eukaryotic cells? They contain compartments called organelles. -- Which statement is true about phagocytosis? Phagocytosis involves the ingestion of bacteria. -- Dysplasia refers to a(n): Modification in the shape of a specific cell type. -- What is the single most common cause of cellular injury? Hypoxic injury -- Shrinkage of the thymus gland during childhood is an example of: Physiologic atrophy -- A patient who is found to have atypical dysplasia should be informed that they have cancer and should be referred to an oncologist immediately for treatment. False -- The two main types of cell death are necrosis and apoptosis. True -- Enlargement of quadricep muscle in a runner is an example of: Physiologic hypertrophy -- In decompression sickness, emboli are formed by bubbles of: Nitrogen -- Which statement is a description of the characteristics of apoptosis? Programmed cell death of scattered, single cells. -- What physiologic change occurs during heat exhaustion? This is considered the most common heat-related injury. Hemoconcentration occurs because of the loss of salt and water. - Free radicals cause cell damage by: Giving up an electron, which causes injury to the chemical bonds of the cell membrane -- Carbon monoxide causes tissues damage by: Binding to hemoglobin so that it cannot carry oxygen. -- Which statement is true regarding the difference between subdural hematoma and epidural hematoma? A subdural hematoma is often the result of shaken baby syndrome, whereas an epidermal hematoma rapidly forms as a result of a skull fracture. -- Which of the following hyperthermic injuries is the most life-threatening and should be treated as a medical emergency? Heat stroke -- Which of the following is a reversible process in regard to replacement of one mature cell type with another cell type? Metaplasia FLUID & ELECTROLYTE / ACID BASE / STRESS, INFLAMMATION & IMMUNITY

-- Despite efforts to eliminate this chemical (which interferes with the function of neurotransmitters) from paint and gasoline, poisonings with this agent continue to occur: Lead -- Long term exposure to this chemical which can be found in fish, vaccines, and dental fillings may be linked to conditions such as ALS, Alzheimer’s disease, MS, and Parkinson’s: Mercury -- What occurs in the cells when the following solutions are given? - Isotonic: No shrinking or swelling of the cells - Hypertonic: Cells shrink - Hypotonic: Cells swell -- A burn patient in the ICU has a generalized third spacing of fluid. What is this called? Anasarca -- Your patient reports severe diarrhea for the past week. He is experiencing the following signs and symptoms: Muscle weakness, cramping, and fatigue. Telemetry reveals frequent arrhythmias. Based on what you know so far, which of the following lab results would you expect to see? Low potassium (normal level is 3.5 - 5.0 mEq/L) The fact that the patient has been having diarrhea for the past week is the way to differentiate between hypo and hyperkalemia) -- Diseases caused by fungi are called: Mycoses -- The clinical hallmark of immune deficiency is what? Recurrent, unusual, and/or severe infections. -- Which are the largest in size of normal white blood cells? Monocytes -- A 34 year old make was hiking in the Grand Canyon in 100 degree heat. He got lost and ran out of water. The only food he had were high protein energy bars. When he was found, he was thirsty, restless, and confused. He is brought to the ER and his serum sodium was 152 mEq/L. What does he have? Hypernatremia (normal level is 135 - 145 mEq/L) -- An isotonic solution has the same concentration of electrolytes in the ICF as in the ECF. -- Which statement is characteristic of HIV? HIV is a retrovirus. -- During a parasitic invasion and an immune response in the human body, which cells are considered to be the primary responders? Eosinophils -- Normal serum calcium level is: 9.0 - 10.5 mg/dL -- What is a result of stress-induced norepinephrine? Peripheral vasoconstriction -- What regulates calcium and phosphate? Parathyroid hormone (PTH), vitamin D, calcitonin -- The hallmark of most infectious diseases is what? Fever -- Match the electrolytes to their characteristic features:

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- Calcium: Major cation for structure of bones and teeth - Sodium: Major cation in the extracellular fluid - Potassium: Major cation in the intracellular fluid -- Which of the organs compensate the fastest for an acid-base imbalance? Lungs -- What is the vascular effect of histamine released from mast cells? Increased vascular permeability -- During a stress response, the helper T (Th) 1 response is suppressed by which hormone? Cortisol -- The initial response of the inflammatory process is activated in order to do what? To prevent infection of the injured tissue -- Where is 2/3 of the body’s water found? Intracellular fluid compartments -- Edema may be caused by: Increased capillary membrane permeability, increased capillary hydrostatic pressure, lymphatic obstruction -- Hypernatremia symptoms: convulsions, pulmonary edema, hypotension, tachycardia -- Hyponatremia symptoms: lethargy, headache, confusion, apprehension, seizures, coma -- Hyperkalemia symptoms: muscle weakness/paralysis, cardiac arrest, dysrhythmias -- Hypokalemia symptoms: skeletal muscle weakness, smooth muscle atony, cardiac dysrhythmias, U wave on ECG -- Hypercalcemia symptoms: kidney stones, muscle weakness, decreased neuromuscular excitability, constipation, heart block -- Hypocalcemia symptoms: increased neuromuscular excitability, muscle spasms, Chvostek ad Trousseau signs, convulsions, tetany GENETICS -- A transient neonatal disease represents which type of reaction? Alloimmune -- The ICF (intracellular fluid) includes: fluid inside the cell -- Chvostek and Trousseau signs indicate which electrolyte imbalance? Hypocalcemia -- Redness, heat, swelling, and pain are four observable signs of the vascular response (inflammation). True -- When a child inherits a disease that is autosomal recessive, it is inherited from: Both parents

-- The most clinically useful technique for prenatal diagnosis of chromosomal abnormalities at 3 months (12 weeks) gestation is: Chorionic villus sampling -- What is the diagnosis of a 13 year old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present with features that include a short stature, wide spaced nipples, reduced carrying angle at the elbow, and sparse body hair? Turner Syndrome (45X) -- Autosomal dominant disease cannot have generational skipping. -- Autosomal recessive disease can have generational skipping. -- The term for an error in which homologous chromosomes fail to separate during meiosis or mitosis is: Nondisjunction -- When a woman has one first-degree relative with breast cancer, her risk of developing breast cancer is how many times greater? Two -- The presence of a zygote having one chromosome with the normal complement of genes and one with a missing gene is characteristic of which genetic disorder? Cri du chat -- Which clinical manifestation would be expected for a child who has complete trisomy of the twenty-first chromosome? An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low set ears. -- What is the most common cause of Down syndrome? Maternal nondisjunction -- The interchanging of genetic material between nonhomologous chromosomes is called ___________. Translocation -- The data reporting that sickle cell disease affects approximately 1 in 600 African Americans is an example of which concept? Prevalence -- Cystic fibrosis is caused by an autosomal recessive gene. -- It is currently believed that the risk for developing Alzheimer’s disease: Doubles among those with an affected first-degree relative. -- It is better to have extra chromosome material than not enough. True -- Match the disease with its chromosomal abnormality. - Down syndrome: an additional chromosome joining the normal homologous pair - Klinefelter syndrome: two X chromosomes and one Y chromosome - Turner syndrome: single X chromosome with no homologous X or Y chromosome - Cri du chat: deletion of the short arm of chromosome 5

-- Match the genetic terms with the corresponding diseases. - Autosomal recessive: sickle cell anemia - X-linked recessive: hemophilia A - Autosomal dominant: Huntington’s disease - Multifactorial: Coronary heart disease -- Consanguinity refers to the mating of: Persons having common family relations -- What is the second most commonly recognized genetic cause of mental retardation? Fragile X syndrome -- A child with which genetic disorder has a characteristic cry? Cri du chat -- DNA formation occurs in which of the cell’s structures? Nucleus -- Match the following: - Short arm: p (petit) - Long arm: q - XY: male - XX: female - First 22 pair of chromosomes: autosomes - The 23 rd pair of chromosomes: sex chromosomes - Mutagen: radiation -- What syndrome, characterized by an absent homologous X chromosome with only a single X chromosome, exhibits features that include a short stature, widely spread nipples, and webbed neck? Turner syndrome -- An amniocentesis indicated a neural tube defect when an increase in which protein is evident? Alpha fetoprotein -- Match the following syndrome with their correct karyotype: - Down’s syndrome: 47 XX or 47 XY (trisomy 21) - Turner’s syndrome: 45 X (monosomy X) - Edward’s syndrome: 47 XX or 47 XY (trisomy 18) - Klinefelter’s syndrome: 47 XXY - Metafemale syndrome: 47 XXX (trisomy X)

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-- The number of new cases of a disease reported during a specific period divided by the number of individuals in the population is defined as which characteristic of a disease? Incidence rate -- When a cell contains three copies of one chromosome it is called: Trisomy -- If one parent suffers from an autosomal dominant disease, their child has a 50% chance of inheriting the mutated gene from the affected parent and therefore inheriting the disease. -- If a boy has hemophilia A, he inherited it from: his mother -- Match the following: - Incidence: The number of new cases of a - Prevalence: The proportion of the population - Monozygotic: Identical twins - Dizygotic: Fraternal twins - Congenital: Present at birth CANCER AND HEMATOLOGY -- Hemolytic disease of the newborn (HDN) can occur if the mother: is Rh-negative and the fetus is Rh-positive -- Fetuses who do not survive anemia in utero are usually stillborn with gross edema of the entire body. Which term is used to identity this condition? Hydrops fetalis -- Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin? Fetal hemoglobin interacts less readily with diphosphoglycerate (DPG), which inhibits hemoglobin-oxygen binding. -- Hallmarks of cancer: - Uncontrolled cellular proliferation - Sustained proliferative signaling - Evading growth suppression - Replicative immortality - Activating invasion and metastasis - Genomic instability - Inducing angiogenesis - Reprogramming energy metabolism -- Hodgkin disease is characterized by the presence of which of the following? Reed-Sternberg (RS) cells

-- In infectious mononucleosis (IM), what does the Monospot test detect? Immunoglobulin M (IgM) -- Which virus is associated with Burkitt lymphoma in African children? Epstein-Barr virus -- In aplastic anemia (AA), pancytopenia develops as a result of what? Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes -- Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? Anemia of chronic disease -- Clinical manifestations of mild-to-moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia? Sideroblastic -- Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails and produces small, pale erythrocytes? Iron deficiency -- During an infectious process, lymph nodes enlarge and become tender because: of the proliferation of B lymphocytes -- The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of the following? Myelin degeneration in the spinal cord -- In order to improve the absorption of an iron supplement, the NP advises the patient to take the supplement with: orange juice (vitamin C) -- After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result? Pernicious -- Most childhood cancers arise from the: Mesodermal germ layer -- What is the effect of low plasma albumin? Osmotic pressure decreases, thus water moves from the capillaries to the interstitium. -- Which is true regarding pain and cancer? Pain can occur a result of pressure caused by the tumor, can indicate the metastasis of a cancer, and is more often associated with late-stage cancer. -- When are childhood cancers most often diagnosed? At peak times of physical growth -- Prenatal exposure to diethylstilbestrol (DES) can result in which type of cancer? Vaginal or cervical cancer -- What congenital malformation is commonly linked to acute leukemia in children? Down syndrome -- What are the three most common childhood cancers? Leukemias, sarcomas, embryonic tumors

-- Benign tumors vs malignant tumors: - Benign – grow slowly, well-defined capsule, not invasive, well differentiated, low mitotic index, do no metastasize - Malignant – grow rapidly, not encapsulated, invasive, poorly differentiated, high mitotic index, can matastasize -- What is the major virus involved in the development of cervical cancer? Human papillomavirus -- A one year old child presents to your clinic after sustaining a bump to the head that was witnessed by his mother. She reports that he did not lose consciousness and the child is noted to be laughing and playing when the NP enters the room. Physical exam is normal. Per citeria for head injuries, imaging is not warranted, however, the mother insists on “a CAT scan”. The NPs best response is: A routine head CT will give the equivalent of 30 regular x-rays, and the risk for a child his age developing cancer is four times higher than an adult, so let’s discuss your concerns further. -- Two “hits” are required to inactive tumor-suppressor genes because: Each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent. -- Oncogenes are genes that are capable of: Undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation. -- Carcinoma in situ is characterized by which changes? Cells remain localized in the glandular or squamous cells. -- Apoptosis is a: Normal mechanism for cells to self-destruct when growth is excessive. -- Carcinoma refers to abnormal cell proliferation originating from which tissue origin? Epithelial cells -- How can chronic inflammation cause cancer? The active immune response in chronic inflammation can predispose one to cancer. -- Exposure to which virus has been shown to increase the risk of developing Burkitt lymphoma, nasopharyngeal carcinoma and Hodgkin disease? Epstein-Barr (EBV) -- Which cancer originates from connective tissue? Osteogenic sarcoma CARDIOVASCULAR SYSTEM -- What condition is consistent with the cardiac defect of transposition of the great vessels? The aorta arises from the right ventricle; the pulmonary artery arises from the left ventricle -- The function of the foramen ovale in a fetus allows for what to occur? Right-to-left blood shunting

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-- ECG definitions: - P wave – represents electrical depolarization just prior to atrial contraction - PR interval – represents the time where the impulse is held up in the AV node before passing to the ventricles - QRS complex – represents ventricular depolarization - ST interval – represents depolarization of the entire ventricular myocardium - QT interval – sometimes referred to as electrical systole of the ventricles; the time it takes for the entire depolarization and repolarization of the ventricles -- Superior vena cava syndrome is a result of a progressive increase in what process? Occlusion -- What best describes Raynaud disease? Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes. -- What type of trauma is associated with fat embolism? Trauma to the long bones; particularly to the lungs -- What is the usual source of pulmonary emboli? Deep venous thrombosis -- What are the 5 Ps of acute peripheral artery disease? Pain, pallor, paresthesia, pulselessness, paralysis -- What factors affect cardiac output? Stroke volume X heart rate -- What is Kawasaki disease? An acute, self-limiting systemic vasculitis that may result in cardiac sequelae, including development of aneurysms of the coronary arteries. -- What is an expected change in the cardiovascular system that occurs with aging? Arterial stiffening -- What should you most suspect in a patient with orthopnea, PND, fatigue, diaphoresis, tachycardia, rales, and a S3? Left sided heart failure -- Malignant hypertension is a potentially life threatening condition, characterized by a rapidly progressive hypertension in which the patient’s: Diastolic blood pressure is above 140 mm/Hg -- When assessing for allergies before a patient undergoes a coronary angiography, you should be particularly concerned if the patient has an allergy to: iodine -- What is false concerning hypertension? Presence or absence of a headache is the most reliable symptom. -- The significance of the ‘atrial kick’ is that it affects the contraction of the: left atria, which increases the blood volume into the ventricle -- Oxygenated blood flows through the: pulmonary veins -- After an electrical impulse leaves the AV node, where does it go next? Atrioventricular bundle (AV bundle; Bundle of His)

-- The resting heart in a healthy person is primarily under the control of what part of the nervous system? Parasympathetic -- Where is the major cardiovascular center in the central nervous system? Brain stem -- To produce an action potential, the sinoatrial node must be stimulated by the autonomic nervous system. FALSE -- Which chamber of the heart endures the highest pressures? Left ventricle -- If the sympathetic nervous system stimulation of the heart predominates over the parasympathetic nervous stimulation, the heart will: Increase its rate -- What does not accurately describe the pericardium? It is made up of connective tissue and a surface layer of squamous cells. -- The two distinct heart sounds of S1 and S2 are most directly related to: Turbulence from the closing of the aortic an mitral valves. -- What may cause mitral regurgitation? Rheumatic heart disease, mitral valve prolapse, infective endocarditis -- If the sinoatrial node (SA) fails, at what rate can the atrioventricular node (AV) polarize? 40- 60 times per minute -- The QRS complex of the EKG represents what? Ventricular depolarization -- The Frank-Starling “law of the heart” concerns the relationship between: The length of the cardiac fiber and strength of contraction -- Deoxygentated blood flows through: superior vena cava, pulmonary ateries, coronary veins -- All of the following assist venous blood return to the heart: competent venous valves, respiratory movements, contraction of skeletal muscles -- What is occurring during diastole? Aortic and pulmonic vales are closed, mitral and tricuspid vales are open -- When the intraventricular pressure reaches that of the pulmonary artery and aorta: The semilunar valves will open -- The heartbeat is typically initiated by the: SA node

PULMONARY SYSTEM -- What is the importance of chemoreceptors? Detecting O2, CO2, H changes in the blood (central: reflects PaCO2 and is stimulated by H changes in the cerebrospinal fluid pH; peripheral: stimulated by hypoxemia and responsible for all increased ventilation that occurs in response to arterial hypoxemia -- Define emphysema: Abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis. -- Define chronic bronchitis: Hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year (usually in the winter months) for at least 2 consecutive years. -- What do cilia do in the respiratory tract? Propel mucous blanket and entrapped particles toward the oropharynx, where they can be swallowed or expectorated. -- Surfactant produced by type II alveolar cells facilitates alveolar distention and ventilation by which mechanism? Decreasing surface tension in the alveoli -- Infants have the same number of alveoli at birth as adults. The alveoli have just not matured. FALSE -- The Virchow triad, which are the three categories of pathologic risks for pulmonary thromboembolism, includes all of the following: venous stasis, hypercoagulability, injury to the endothelial lining of the lungs -- What is cyanosis? A bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin in the blood. -- A child has rhinorrhea, sore throat, and a low-grade fever, which is followed by a seal-like barking cough. These clinical manifestations are indicative of which upper airway disorder? Croup (laryngotracheobronchitis) -- The pathophysiology of chronic bronchitis can be explained by what description? Increase in the number and size of mucous glands and goblet cells in airway epithelium. -- Atelectasis is the main problem in respiratory distress syndrome of the newborn. Causes of atelectasis include: Reduced alveolar surface area, a weak and compliant chest wall, reduced surfactant -- Approximately 1000 mL (1L) of oxygen is transported to cells each minute. How is most of the oxygen transported? Bound to hemoglobin and plasma -- Clinical manifestations of inspiratory crackles, increased tactile fremitus, egophony, and whispered pectoriloquy are indicative of what respiratory condition? Pneumonia -- What is true regarding the pulmonary structure? The right lung has 3 lobes and the left has 2 lobes, cilia can function as a defense mechanism, the carina is sensitive and can cause temporary airway obstruction when stimulated.

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-- How is most carbon dioxide (CO2) in the blood transported? In the form of bicarbonate -- What is a normal physiologic change regarding the respiratory unit in the lungs? Decreased elastic recoil -- The oblique fissure can be found in both the right and left lungs. Where would you expect to find the horizontal fissure? The right lung -- Kussmaul respirations as a respiratory pattern may be associated with what characteristic? Slightly increased ventilatory rate, large tidal volumes, and no expiratory pause. -- Which inflammatory mediators are produced in asthma? Histamine, prostaglandins, and leukotrienes -- The adequacy of a person’s alveolar ventilation is assessed best by monitoring which mechanism? Arterial blood gas -- What is true concerning the respiratory system? The major muscles of inspiration include the diaphragm and the external intercostals. -- In ARDS, damage to alveoli and increased alveolocapillary membrane permeability can be due to all of the following: inhalation of toxic gases, inflammatory cytokines, and genetic factors -- How does chest wall compliance in an infant differ from that of an adult? An adult’s chest wall compliance is lower than an infant’s. -- What is the primary cause of respiratory distress syndrome (RDS) of the newborn? Decreased surface area for gas exchange and lack of adequate surfactant -- What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx? Ciliated epithelial cells -- Bronciolitis tends to occur during the first years of life and is most often caused by what type of infection? Respiratory syncytial virus (RSV) -- Clinical manifestations of inspiratory and expiratory wheezing, dyspnea, nonproductive cough, and tachypnea are indicative of what condition? Asthma -- What term is used to describe the selective bulbous enlargement of the distal segment of a digit that is commonly associated with diseases that interfere with oxygenation of the blood? Clubbing -- The most successful treatment of chronic asthma begins with what action? Elimination of the causative agent – allergens and triggers -- The most common cause of pulmonary edema is left-sided heart failure. What is the reason for the fluid shift? Opposing hydrostatic pressure in the vessels

NEUROLOGICAL SYSTEM -- It is true that myasthenia gravis: causes muscle weakness -- What nutritional deficiency in a pregnant woman is associated with neural tube defects? Folate -- What term is used to describe the complication that can result from a spinal cord injury above T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the spinal cord lesion? Autonomic dysreflexia -- It is true that Guillain-Barre syndrome (GBS): is preceded by a bacterial or viral illness -- Which type of ischemic stroke occurs due to atherosclerosis? Thrombotic -- In an automobile accident, an individual’s forehead struck the windshield. The coup/contrecoup injury would occur in which area of the brain? Frontal/occipital region -- Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in the brain’s: substantia nigra that produces dopamine -- Amyotrophic lateral sclerosis (ALS) is characterized by: progressive upper and lower motor neuron degeneration -- What type of posturing exists when a person with a severe closed head injury has all four extremities in rigid extension with the forearms in hyperpronation and the legs in plantar extension? Decerebrate -- Neurofibrillary tangles characterize which neurologic disorder? Alzheimer disease -- Cheyne-Stokes respirations are described as: crescendo-decrescendo pattern of breathing, followed by a period of apnea -- What term describes the loss of the comprehension or production of language? Aphasia -- Which medication is used to reverse the effects of malignant hyperthermia? Dantrolene sodium -- A scotoma may be a sign of impending optic neuritis, alerting the NP to evaluate for: multiple sclerosis (MS) -- Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation? Heat exhaustion -- A patient with prolonged exposure to high environmental temperatures is no longer sweating and his skin has become flushed and dry. What is the most likely diagnosis? Heat stroke -- Which pain theory explains how rubbing a painful area may decrease the perception of pain? Gate control theory

-- What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding? Tolerance -- The end of the spinal cord is known as the conus medullaris. At what level does the spinal cord end? L1-L2 -- The region between the adjacent neurons is called: synapse -- What statement best describes visceral pain? Pain in the internal organs and abdomen that is transmitted by the sympathetic nervous system. -- The primary vision cortex is located in which area of the brain? Occipital lobe -- The collateral blood flow to the brain is provided by the: Circle of Willis -- Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture? Cerebellum -- Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? Medulla oblongata -- Parkinson’s and Huntington’s diseases are associated with defects in the: basal ganglia -- Neurons are specialized for the conduction of impulses, whereas neurolgia: support the neurons -- What name is given to a large network of neurons within the brainstem that is essential for maintaining wakefulness or consciousness? Reticular activating system -- Which pathway carries sensory information toward the central nervous system (CNS)? Ascending -- Schwann cells have the ability to: form and maintain a myelin sheath DIGESTIVE SYSTEM -- Where in the brain is the vomiting center located? Medulla oblongata -- What is the most common site for diverticulitis to occur? Left colon -- Which elements in saliva protect against tooth decay? Bicarbonate secretion and a pH of 7.4 -- Inhaling and forcing the diaphragm and chest muscles against the closed glottis to increase intrathoracic pressure is called? Valsalva maneuver -- How can abdominal pain that is visceral in nature best be described? Abdominal pain that is visceral in nature is diffused, vague, poorly localized, and dull. -- Which type of hepatitis requires Hepatitis B for replication? D -- What is the approximate daily absorption of calcium? 600mg

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-- Which of the following disorders is one of the most common GI emergencies in the newborn? Symptoms include blood stools, abdominal distention, and residuals, and if left untreated a portion of the intestine becomes necrotic and dies. Necrotizing enterocolitis -- The gastric parietal cells secrete which of the following? HCL, intrinsic factor, and gastroferrin -- Which term is used to identify a condition in which the developing colon remains in the upper right quadrant instead of moving to its normal location? Intestinal malrotation -- A patient with celiac disease receiving dietary counseling is instructed to avoid _______. Whole wheat bread -- An infant with a meconium ileus should be tested for: cystic fibrosis -- The primary source of blood supply to the liver is through the: portal vein -- Unlike Crohn disease, ulcerative colitis is characterized by skip lesions. FALSE. Skip lesions are seen in Crohn disease. -- Which anomaly would put an infant at the highest risk of aspiration? Tracheoesophageal fistula -- The ileocecal valve: marks the junction between the terminal ileum and large intestine. -- The most common clinical manifestation of portal hypertension is _______ bleeding. Esophageal -- Peyers patches are lymph nodules containing lymphocytes, plasma cells, and macrophages. Their role is to produce what? Produce antimicrobials and IgA -- In the mouth and stomach, salivary a-amylase initiates the digestion of which nutrients? Carbohydrates and sugars -- What are carbohydrates broken down into? Monosaccharides and disaccharides -- All of the following are clinical manifestations associated with the classic pathophysiological triad of cystic fibrosis, EXCEPT: nausea and vomiting cause by hypermotility (Other answers include: pancreatic enzyme deficiency that leads to maldigestion; overproduction of mucus in the respiratory tract that leads to chronic obstructive pulmonary disease; elevated levels of sodium and chloride in perspiration) -- Bilirubin is a by-product of the destruction of which aged cells? Erythrocytes -- Of the list below, choose the immunoglobulins (Ig) that are not contained in the saliva. IgE, IgM, and IgD (Other answers include: IgD, IgA, and IgE; IgA, IgE, and IgM; IgM, IgA, and IgG) -- What type of vomiting is caused by the direct stimulation of the vomiting center by neurologic lesions involving the brainstem? Projectile

-- Bile is stored and concentrated in which organ? Gallbladder -- When the digestive system is unable to absorb certain vitamins (i.e. vitamin B12), this can result in what condition? Pernicious anemia RENAL SYSTEM -- A patient is experiencing right-sided back pain. The NP would include pain related to the kidney in the list of differential diagnoses if the pain was located at what level? T12 - L3 -- What is the most common cause of uncomplicated urinary tract infections? Escherichia coli -- Vesicoureteral reflux causes urine to retrograde up the ureters and places the young child at risk for _______. Pyelonephritis -- What medical term is used to identify a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder? Neurogenic bladder -- What is the first indication of nephrotic syndrome in children? Periorbital edema -- Which hormone is required for water to be reabsorbed in the distal tubule and collecting duct? Antidiuretic hormone (ADH) -- How much urine accumulates in the bladder to contract and what are the mechanoreceptors which sense bladder fullness, innervated by? 250-300mL, parasympathetic, S2-S4 -- When does urine formation and excretion begin? By 3 months gestation -- The presence of WBC casts are indicative of __________. Pyelonephritis -- At the end of the proximal convoluted tubule, only what % of sodium and water is excreted? 60-70% -- Which mineral accounts for the most common type of renal stone? Calcium oxalate -- Kidney stones in the upper part of the ureter could produce referred pain to the: umbilicus -- Mesangial cells are similar to antigen presenting cells in what way? They can release chemokines, inflammatory cytokines, and growth factors -- The number of nephrons will increase until the child reaches adolescence. FALSE. All nephrons are present at birth. -- Immunologic abnormalities such as lupus erythematosus and diabetes mellitus are both common causes of glomerulonephritis. TRUE. -- What is the end-product of protein metabolism that is excreted in urine? Urea -- What makes up the functional unit of the kidney? Renal corpuscle, proximal convoluted tubule, and collecting duct.

-- Infants produce more dilute urine because of: shorter loops, and increased blood flow to the kidneys -- The proximal convoluted tubule’s primary function is the reabsorption of: potassium -- Two major indicators of renal function are: BUN and plasma creatinine levels -- The _________ arteries arise as the fifth branches of the abdominal aorta and are the main source of blood supply to the kidneys. Left and right renal -- Innervation of the bladder and internal urethral sphincter is supplied by which nerves? Parasympathetic fibers -- On average, what percent of cardiac output do the kidneys receive? 25% -- Post streptococcal glomerulonephritis often occurs after an infection with beta-hemolytic streptococci infection. This might be seen after: pharyngitis and impetigo -- An alkaline urinary pH significantly decreases the risk of calcium phosphate stone formation, whereas acid urine decreases the risk of uric acid stones. FALSE. REPRODUCTIVE SYSTEM -- A woman diagnosed with trichomoniasis asks if her sexual partner should be treated as well. What is the appropriate response? Sexual partners should be treated even if they are asymptomatic. -- Which organism is responsible for the development of syphilis? Treponema pallidum -- In which stage of syphilis would the following clinical manifestations be found: destructive skin, bone, and soft tissue lesions, aneurysms, heart failure, and neurosyphilis? Tertiary -- What is the major concern regarding the treatment of gonocci infections? Development of antibiotic resistance -- How does an established gonococcal infection usually express itself in newborns? Eye infection -- When a patient has small, vesicular lesions that last between 10 and 20 days, which sexually transmitted infection is suspected? Genital herpes -- Acute pelvic inflammatory disease (PID): may cause infertility and tubular pregnancy. -- Which of the following statements provides the most accurate information regarding the transmission of HSV? There is a risk of transmission even during laten periods and this is called asymptomatic viral shedding. -- Cryptorchidism is: failure of testes to descend into the scrotum. -- Phimosis is: a condition in which the foreskin cannot be retracted.

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-- Which virus is a precursor for developing cervical intraepithelial neoplasia (CIN) and cervical cancer? Human papillomavirus (HPV) -- Which sexually transmitted infection frequently coexists with gonorrhea? Chlamydia -- Which term is used to identify the descent of the posterior bladder and trigone into the vaginal canal? Cystocele -- Which term is used to identify benign uterine tumors that develop from smooth muscles cells in the myometrium and are commonly called uterine fibroids? Leiomyomas -- What statement concerning the pathogenetic mechanisms of polycystic ovarian syndrome (POS) is true? POS is a result of a combination of conditions that include oligo-ovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. -- What is the leading cause of infertility? Polycystic ovarian syndrome -- If benign prostatic hyperplasia, enlargement of periurethral tissue of the prostate causes: obstruction of the urethra. -- The release of which chemical mediator causes primary dysmenorrhea? Prostaglandins -- The infectious cause of orchitis is: mumps virus. -- Which organisms can cause epididymitis? Enterobacteriaceae, Neisseria gonorrhoeae, chlamydia trachomatis -- The function of the glands of Montgomery in breastfeeding include: lubrication. -- Having ejected a mature ovum, the ovarian follicle develops into: a corpus luteum. -- What is the first sign of puberty in girls? Breast enlargement -- Thelarche is defined as: the onset of breast development. -- When does the male body begin to produce sperm? At puberty -- Which hormone is known as the ‘hormone of pregnancy’? Progesterone -- GnRH reaches the anterior pituitary gland and stimulates the release of which of the following? FSH and LH -- Where in the male body does spermatogenesis occur? Seminiferous tubules -- Progesterone: maintains the thickened endometrium. -- The initial reproductive structures of the male and female embryos appear the same until approximately which week of gestation? Eighth week MUSCULOSKELETAL SYSTEM

-- An insufficient dietary intake of which vitamin can lead to rickets in children? Vitamin D -- Until the skeleton matures an adults stature is reached, where does growth in the length of bone occur? Physeal plate -- Which bones are affected in Legg-Calve’-Perthes disease? Femoral heads -- Which of the statements concerning JRA are true? JRA predominantly affects large joints -- After puberty, the epiphyseal plate calcifies and the epiphysis merges with the ________. Metaphysis -- What is Osgood-Schlatter disease? Tendinitis of the anterior patellar tendon -- A bone density of 645mg/cm2 would support which diagnosis? Osteoporosis -- Cerebral palsy is usually the result of: perinatal brain ischemia -- A tear in a ligament is referred to as a: sprain. -- How is rhabdomyolysis characterized? Release of myoglobin from damaged striated muscle cells. -- ________ fractures usually occur in individuals who engage in a new activity that is strenuous and repetitive. Stress -- Which structure attaches skeletal muscle to bone? Tendon -- Age related bone loss typically begins in the ______ decade of life. Third – fourth -- ____________ is the temporary displacement of two bones in which the bone surfaces partially lose contact. Subluxation -- What causes crystallization within the synovial fluid, which leads to acute, painful inflammation of the joint in gouty arthritis? Overproduction of uric acid -- What type of fracture occurs at the site of preexisting bone abnormality and is a result of a force that would not normally cause a fracture? Pathologic -- Which of the following describes a chronic, inflammatory joint disease, characterized by stiffening and fusion of the spine and sacroiliac joints? Ankylosing spondylitis -- What causes the bone to die in osteomyelitis? Localized ischemia -- Which disorder is characterized by the formation of new bone at an accelerated rate beginning with excessive resorption of spongy bone? Paget disease -- The double layer structure that covers bone is the: periosteum -- Which component is found in synovial fluid? Leukocytes -- Which type of ion directly controls the contraction of muscles? Calcium

-- Which of the following describes a functional muscle contraction in which the muscle contracts but the limb does not move? Isometric contraction -- Which terms describes a freely movable joint? Diarthrosis -- In which type of contraction does the muscle maintain a constant tension as it moves? Isotonic -- Which cells function to maintain bone matrix? Osteocytes -- What is the basic structural unit in compact bone? Haversian system -- In the muscle, these are responsible for converting energy into movement. Sarcomeres -- What is the name of the bone cell that is responsible for laying down new or secondary bone? Osteoblast

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